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Outline. Sinus Arrhythmia and Sick Sinus SyndromeMultifocal Atrial TachycardiaBigeminal RhythmsPreexcitation and AVRT. Mechanisms of Arrhythmogenesis. Sinus Arrhythmia. EKG Characteristics:Presence of sinus P wavesVariation of the PP interval which cannot be qattributed to either SA nodal block or PACsWhen the variations in PP interval occur in phase with respiration, this is considered to be a normal variant. When they are unrelated to respiration, they may be caused by the same 197
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1. Arrhythmias and EKGs Part 2
2. Outline Sinus Arrhythmia and Sick Sinus Syndrome
Multifocal Atrial Tachycardia
Bigeminal Rhythms
Preexcitation and AVRT
3. Mechanisms of Arrhythmogenesis
4. Sinus Arrhythmia
5. Sick Sinus Syndrome Characterized by a collection of symptoms and ECG findings due to chronic dysfunction of the sinoatrial (SA) node:
Chronic and severe sinus bradycardia
Sinus pauses
Sinus arrhythmia
Complete sinus arrest
Progressive development of atrial arrhythmias (a-flutter, a-fib, atrial tachycardia)
Patients are usually elderly and present with lightheadedness and/or syncope, but it can also manifest as angina, dyspnea, and palpitations.
About 50% of people with SSS also display some degree of dysfunction of the AV node
6. Sick Sinus Syndrome
7. Etiologies of Sick Sinus Syndrome
8. Tachycardia-Bradycardia Syndrome Common variant of sick sinus syndrome severe bradycardia alternates with paroxysmal tachycardias, most often atrial fibrillation.
There is usually a prolonged pause in the cardiac rhythm following cessation of the tachyarrhythmia.
9. Tachycardia-Bradycardia Syndrome
10. Multifocal Atrial Tachycardia
11. Bigeminal Rhythms Arrhythmias in which each normal sinus beat is followed by a premature contraction (PAC, PJC, or PVC).
Results in a couplet rhythm which can be detected by pulse or auscultation.
Generally benign
12. Atrial Bigeminy
13. Ventricular Bigeminy
14. Preexcitation
15. AV Reentrant Tachycardia (AVRT) In patients with WPW, a reentrant rhythm can be generated where the AV node serves as one arm of the reentrant circuit, and the accessory pathway as the other.
16. Types of AVRT Orthodromic AVRT (More common) Narrow complex tachycardia in which the wave of depolarization travels down the AV node and retrograde up the accessory pathway.
Antidromic AVRT (Less common) Wide complex tachycardia in which the wave of depolarization travels down the accessory pathway and retrograde up the AV node.
17. Mechanism of orthodromic AVRT
18. Mechanism of antidromic AVRT
19. What is this arrhythmia?
20. Classification Scheme for Arrhythmias